Female federal university's students' knowledge of sexually transmitted diseases


Thaís Cristina EliasI; Taciana Nunes dos Santos II; Maurícia Brochado Oliveira SoaresIII; Nathália Silva GomesIV; Bibiane Dias MirandaV ; Sueli Riul da SilvaVI

I Nurse. Master of Health Care. Graduate course in Health Care from the Federal University of Triângulo Mineiro. Uberaba, Minas Gerais, Brazil. E-mail: thaiscelias2@hotmail.com
Nursing undergraduate student at Federal University of Triângulo Mineiro. Uberaba, Minas Gerais, Brazil. E-mail: taciana.nunes@hotmail.com
Obstetric nurse. Ph.D. in Health Care. Graduate course in Health Care from the Federal University of Triângulo Mineiro. Uberaba, Minas Gerais, Brazil. E-mail: mauricia_olive@yahoo.com.br
Nurse. Master of Health Care. Doctoral student in Health Care from the Federal University of Triângulo Mineiro. Uberaba, Minas Gerais, Brazil. E-mail: nathaliasilvagomes@hotmail.com
Obstetric nurse. Ph.D. in the graduate course at the Ribeirão Preto College of Nursing at the University of São Paulo. Uberaba, Minas Gerais, Brazil. E-mail: bibianedias@yahoo.com.br
VI Nurse. Ph.D. in Nursing. Associate professor in the graduate course in Health Care from the Federal University of Triângulo Mineiro. Uberaba, Minas Gerais, Brazil. E-mail: sueliriul@terra.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2017.10841




Objective: to describe female university students' knowledge of sexually transmitted infections (STIs) and to ascertain whether contracting an STI interfered in the knowledge they showed of these diseases. Method: in this quantitative, cross-sectional study, conducted at the Federal University of the Triângulo Mineiro, a questionnaire relating to knowledge and attitudes about STIs was applied, from August to December 2012, to 298 first-semester female university students. The study was approved by the university's research ethics committee under protocol 2,087. Results: the STIs most cited by the group were AIDS, syphilis and gonorrhea, revealing a knowledge deficit and, consequently, risk attitudes and behaviors. Students who had contracted such infections showed greater knowledge about STIs. Conclusion: the female university students had some information about STIs, however incipient. There is a need to implement health education activities directed to this population, which displays great vulnerability.

Keywords: Sexually transmitted diseases; women's health; health education; sexual behavior.




The search for sexual freedom and the scientific advances in the development of new types of medication has negatively influenced sexual practice, contributing to increase predisposition to contracting sexually transmitted infections (STIs) and developing the acquired immunodeficiency syndrome (AIDS). The concern about these diseases is not so significant among new generations as it was for prior ones. As a consequence, young people started to adopt practices contrary to the proper preventive measures to avoid STIs/AIDS. Thus, the false impression of safety experienced by this population increasingly leads to risky sex habits 1.

Having unprotected sex and acquiring STIs/AIDS can cause a significant impact on women's health and lead to infertility and cervical cancer (CC), which is directly related to the infection by the human papillomavirus (HPV). The estimate of new CC cases in Brazil is around 15.85 for each 100,000 women for the 2016-2017 biennium, a number that evidences the high incidence of the disease and warns about its impact for the public health system2.

In addition, studies3-5 show the deficit of knowledge of STIs/AIDS by teenagers and young people; those that have information about the diseases do not use it in their daily practice6. This can be explained by the sense of invulnerability, the establishment of a stable relationship and the use of contraception methods, among other factors. Education and information do not guarantee a behavioral change to prevent STIs/AIDS, but increase the chance to adopt healthy sexual habits and consequently decrease the susceptibility to these conditions7.

The vulnerability of these young people is related to socioeconomic problems, such as low level of education, low income, promiscuity, refusal to use condoms and an early start of sex life8.

Nursing professionals play an important role in the development of preventive actions to increase people's knowledge of health matters and the adoption of a healthier lifestyle, encouraging individuals to be responsible for their own care before the STIs/AIDS menace9.

The objectives of the present study are to describe the knowledge of university students of STIs and verify whether having these diseases interferes with their understanding of the subject.



The Ministry of Health aims to guarantee sexual health to adults, young people and teenagers by issuing guidelines and developing strategies involving the decentralization of health services, investments in research related to the topic, availability of medications and professionals at the Unified Health System (SUS) and creation of programs to combat STIs/AIDS. The Clinical Protocol and Therapeutic Guidelines for Comprehensive Care to People with Sexually Transmitted Diseases, one of these initiatives, is a document to guide managers on the program and operational handling of the complications caused by the conditions, and healthcare professionals on the triage, diagnosis, treatment and preventive measures oriented to the target population and/or people with STIs and their sexual partners10.

The incidence of STIs/AIDS in young people in Brazil is high enough to be seen as a public health issue. The rate of detected cases reported in 2015 in women aged 20 to 24 years old was 11.1 in every 100,000 people and 4.1 in women aged 15 to 19 years old11.

A study carried out in João Pessoa, state of Paraíba, with teenagers and young people, showed that masculinity and gender subjects influence negatively the sexual behavior of women, increasing their vulnerability to STIs/AIDS12.

The adoption of preventive methods in sexual practice is directly related to attitudes of gender equality, which may lead to a decrease in female vulnerability and a higher control of STIs/AIDS13. In this way, it is important to ensure sex education and comprehensive health care to young women.

Taking into account that nursing professionals develop activities directly related to people, trying to contribute to the adoption of healthy habits 14, it is necessary to know the practices and attitudes of this share of the population so that they can work effectively and help prevent these diseases.



The present study was a quantitative and cross-sectional survey carried out in the Federal University of Triângulo Mineiro with students from 23 undergraduate courses: Biomedicine, Biological Sciences, Physical Education, Nursing, Physics, Physical Therapy, Geography, History, Languages, Mathematics, Medicine, Nutrition, Psychology, Chemistry, Social Service, Occupational Therapy and the following branches of Engineering: Environmental, Civil, Food, Production, Electrical, Mechanical and Chemical.

The investigated population consisted of 298 students from these courses. No calculation was done to define the sample because of the limited number of young people. All female students older than 18 years regularly registered in the courses were included in the study. In the case of semi-annual courses, the students were in the first semester; for annual programs, the selected participants were in the first year.

Data collection took place from August to December 2012, by means of a questionnaire designed by the authors based on a detailed literature survey and the Ministry of Health's guidelines.

The students were approached and learned about the importance and objective of the study and the procedures they would be submitted to. After accepting to participate and signing the free and informed consent form, the instruments were distributed to be filled out by the students in the classrooms, during breaks or in the end of their classes, with the consent and authorization of the professors in charge.

The questionnaire had the objective to gather sociodemographic data, such as age, occupation, income and marital status and contained questions about the students' knowledge of STIs/AIDS and their attitudes and practices regarding the subject.

Data analysis was performed through a statistical analysis run by the Statistical Package for the Social Sciences (SPSS) software, version 17.0. The analysis of quantitative and category variables used descriptive statistics and the interpretation of the results took into account a quantitative context and was expressed numerically.

The study was submitted to and approved by the Human Research Ethics Committee of the Federal University of Triângulo Mineiro, which issued a protocol labeled 2087.



The average age of the undergraduate students was 20.3 years, and 267 or 89.6% had the studies as their main occupation; 220 or 73.8% did not have their own income and depended on relatives financially. Two thirds of the women (199 or 66.8%) attended daytime courses. Most (260 or 87.2%) were single, 200 or 67.1% had already had intercourse, 185 or 62.1% were sexually actives and 82 or 44.3% declared not to have a steady partner. The age of sexual initiation varied from 14 to 30 years, with an average of 17.3 years.

These data corroborate an investigation carried out with young people from a public university in the state of Piauí, which reported that most people did not have a steady partner and had their sexual initiation at 16 years of age15. The ages 16 and 17 years are the most cited by teenagers when questioned about the start of sexual practice 15,16.

It is known that the age of sexual initiation has been decreasing and that the younger the people and the lower their level of education, the lower their chance to use condoms17. This illustrates the need to intensify educational activities with a focus on protected sex practices oriented to female teenagers and young women to decrease their vulnerability to STIs.

As for appointments with gynecologists, 260 or 87.2% said they have experienced that, and 159 or 53.4% claimed to visit their physician annually; 66 or 21% answered that they look for help only when they notice a different sign or have a symptom.

In the section of STIs of the questionnaire, the most marked diseases were, in order of frequency, AIDS, syphilis and gonorrhea. The least known or heard of were chancroid (71), trichomoniasis (44), bacterial vaginosis (43) and lymphogranuloma venereum (15), as can be seen in Table 1. A study about knowledge and teaching of sexually transmitted diseases found that university students had a limited knowledge of prevention, treatment, and identification of lesions resulting from STIs18. A survey carried out with teenagers in a city in the state of São Paulo, similar to the present study, revealed that AIDS and herpes were the most known STIs 6. Another investigation with the same age group pointed AIDS, HIV, syphilis, gonorrhea, HPV and genital herpes as the most cited diseases; again, chancroid was cited by few people19.

An investigation that took place in Florianópolis, state of Santa Catarina, showed that although the young people could verbalize some knowledge of STIs, they had many doubts, curiosities and misconceptions; they had more information about AIDS, probably because of its severity and dissemination in the media4.

Corroborating the data of the present study, other investigations report the lack of knowledge of signs and symptoms of STIs/AIDS5, 18. This stresses the need to develop health education activities for this population, despite the varied means of information and their ease of access, such as internet, television, and radio.

According to the results, the most known symptom of STIs is warts in the genitalia, chosen by 214 students, followed by vaginal discharge (195), dyspareunia (171) and discharge and redness in the vulva (158). The less known symptom is intense and persistent pain in the abdomen, marked by 70 students. It is important to emphasize that 34 participants informed not to know the answer to this question, as exhibited in Table 1.

Young people's knowledge of symptoms of STIs leads to the spontaneous search for help in health services. However, it is also necessary to extend the dissemination of information about asymptomatic STIs, which account for most prevalent and common infections and can have a delayed diagnosis, causing negative consequences to women's health16, 19.

TABLE 1: Students' knowledge of sexually transmitted infections. Uberaba, Minas Gerais, 2014.

*Questions allowed more than one answer.

Regarding problems in the past, 13 (4.4%) students reported to have had an STI, 12 (4%) referred to vaginal discharge, 11 (3.7%) mentioned vaginal itching, 2 (0.7%) had ulcers and/or lesions and 1 (0.3%) developed a vaginal wart.

A survey in Rio de Janeiro, whose sample was high school students in the age group from 14 to 20 years, revealed that 5% of public school students declared to carry or have carried an agent that causes STIs, versus 7.5% in private schools3. These values are higher than those obtained in the present study.

All the participants that contracted an STI said they sought for a proper treatment in health services. It is paramount to stress the need to examine and treat sex partners too, who can benefit if there is a long-term relationship or an affectional bond, according to literature20.

When relating the results of the question about contamination with an STI to the outcomes of the question regarding the diseases that are sexually transmitted, it was observed that, among the 13 (4.4%) people that confirmed to have had an STI, 13 (100%) cited syphilis, 5 (38.5%) mentioned chancroid, 11 (84.6%) marked herpes, 10 (76.9%) included candidiasis, 12 (92.3%) referred to gonorrhea, 4 (30.7%) knew of chlamydia and 271 (97.8%) indicated AIDS. These results showed that the students that claimed to have been infected with an STI had a deeper knowledge of this type of disease, probably as a consequence of being interested in their own health.

Young people usually rely on friends to obtain guidance on STIs/AIDS. This source of information can spread inaccurate facts and encourage unsafe sex practices21. It is necessary to promote healthy sexual behaviors 22, in addition to prevent STIs/AIDS, and nurses, as part of multidisciplinary health teams, can help people adopt protected sex practices through health education.



In the examined sample, most students were single and sexually active. Syphilis and HIV were cited as the most known and chlamydia and chancroid as the least known STIs. The most reported signs and symptoms were genital warts and vaginal discharge; only a minority of students could not identify them. The women that contracted STIs presented vaginal itching and discharge and were assisted in health services to get a proper treatment. The students that had already had an STI had a deeper knowledge of these conditions than the other participants.

The findings of the survey revealed that these university students have information about STIs, but it is incipient, which evidences the need to implement health education activities oriented to this population, whose vulnerability is higher for being sexually active and not having healthy sexual behaviors. Effective health education can be accomplished only if professionals deepen the knowledge of this public. Guidance must be specific and direct, taking into account the preexisting knowledge and aiming to develop in these people the responsibility for their own health.

The authors suggest that similar studies are performed in other universities for comparison of profiles. A limitation of the survey was the absence of a reserved place to apply the questionnaire, which may have led to embarrassment and influenced the answers.



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